Neighbourhood child population density as a proxy measure for exposure to respiratory infections in the first year of life: A validation study

PLoS One. 2018 Sep 12;13(9):e0203743. doi: 10.1371/journal.pone.0203743. eCollection 2018.


Background: Assessing exposure to infections in early childhood is of interest in many epidemiological investigations. Because exposure to infections is difficult to measure directly, epidemiological studies have used surrogate measures available from routine data such as birth order and population density. However, the association between population density and exposure to infections is unclear. We assessed whether neighbourhood child population density is associated with respiratory infections in infants.

Methods: With the Basel-Bern lung infant development study (BILD), a prospective Swiss cohort study of healthy neonates, respiratory symptoms and infections were assessed by weekly telephone interviews with the mother throughout the first year of life. Using population census data, we calculated neighbourhood child density as the number of children < 16 years of age living within a 250 m radius around the residence of each child. We used negative binomial regression models to assess associations between neighbourhood child density and the number of weeks with respiratory infections and adjusted for potential confounders including the number of older siblings, day-care attendance and duration of breastfeeding. We investigated possible interactions between neighbourhood child population density and older siblings assuming that older siblings mix with other children in the neighbourhood.

Results: The analyses included 487 infants. We found no evidence of an association between quintiles of neighbourhood child density and number of respiratory symptoms (p = 0.59, incidence rate ratios comparing highest to lowest quintile: 1.15, 95%-confidence interval: 0.90-1.47). There was no evidence of interaction with older siblings (p = 0.44). Results were similar in crude and in fully adjusted models.

Conclusions: Our study suggests that in Switzerland neighbourhood child density is a poor proxy for exposure to infections in infancy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Cohort Studies
  • Female
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Interviews as Topic
  • Male
  • Models, Theoretical
  • Population Density
  • Residence Characteristics
  • Respiratory Tract Infections / diagnosis*
  • Respiratory Tract Infections / epidemiology
  • Risk Factors
  • Siblings
  • Surveys and Questionnaires
  • Switzerland / epidemiology
  • Telephone

Grants and funding

This study was supported by the Swiss National Science Foundation (#320030_163311, #3200-B0-112099), Swiss Cancer Research (# 3049-08-2012, # 3515-08-2014, # 4012-08-2016). B.D. Spycher was supported by a Swiss National Science Foundation fellowship (PZ00P3_147987). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.